Provider First Line Business Practice Location Address:
746 CUMBERLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-304-2631
Provider Business Practice Location Address Fax Number:
570-581-8089
Provider Enumeration Date:
11/06/2025